System and method for displaying a histogram of cardiac events

ABSTRACT

Systems, devices and methods are provided for displaying statistical distributions of cardiac events. A device embodiment comprises circuitry adapted to communicate with a medical device that is adapted to acquire data regarding cardiac events occurring at two or more cardiac sites, and display means for displaying a histogram of the data as two or more statistical distributions for the two or more cardiac sites. The histogram includes a number of histogram bins. At least one of the histogram bins includes both a representation for at least a portion of a statistical distribution of a cardiac event for a first cardiac site and a representation for at least a portion of a statistical distribution of a cardiac event for a second cardiac site. Other embodiments are provided herein.

CLAIM OF PRIORITY

This application is a continuation of U.S. patent application Ser. No.12/169,432, filed on Jul. 8, 2008, now issued as U.S. Pat. No.8,032,208, which is a continuation of U.S. patent application Ser. No.11/115,618, filed on Apr. 27, 2005, now issued as U.S. Pat. No.7,406,348, which is a continuation of U.S. patent application Ser. No.09/738,868, filed on Dec. 15, 2000, now issued as U.S. Pat. No.6,941,167, the specifications of which are incorporated herein breference.

FIELD OF THE INVENTION

This invention relates generally to the field of medical devices, andmore particularly to systems and methods for graphically displayingcardiac events.

BACKGROUND

Medical devices, including cardiac stimulus devices such as implantablecardiac pacemakers and implantable cardioverter defibrillators (ICDs),are surgically implanted within a patient. Cardiac stimulus devices haveone or more electrical leads with one or more electrodes that conductsignals to and receive signals from the patient's heart. These lead(s)and their electrode(s) are placed in or around the heart. Each of theelectrodes may be configured either to produce or pace a cardiac event,or to detect or sense an intrinsic cardiac event. Some medical devicesrecord or otherwise collect these cardiac events.

A programming device or programmer communicates with the medical devicethrough a communication link. The collected data regarding the paced andsensed cardiac events is transferred from the medical device to theprogrammer through the communication link. One example of acommunication link is a telemetry link that provides means for commandsand data to be non-invasively transmitted and received between theprogrammer and the device.

Medical devices collect more cardiac events at more cardiac sites asthey provide more leads, electrodes per lead, and programming parametersfor the leads. Thus, there is a greater need to present these cardiacevents in a meaningful manner for comparison. For example, in the caseof heart failure resynchronization, there is a need to determine howoften a patient needs therapy and how often the patient is receivingtherapy. Heart failure therapy relies on providing programmed pacedcardiac events in a chamber or combination of chambers, and failure todeliver these programmed paces is viewed as therapy failure. It isimportant to provide the clinician with diagnostics that reveal the lossof therapy as well as the reason for the loss of therapy. Based on thisinformation, the clinician attempts to optimize the operation of themedical device for a particular patient by adjusting programmableparameters in the medical device.

Therefore, there is a need in the art to provide a system and method fordisplaying cardiac events in a meaningful manner.

SUMMARY OF THE INVENTION

The present subject matter addresses the aforementioned problems byproviding a display that can be used to view and compare cardiac eventsthat occurred at two or more cardiac sites. More particularly, thepresent subject matter displays data from two or more sites of a heartin a graph as two or more statistical distributions for the two or moresites.

One aspect provides a programmer device that generally comprisescircuitry for communicating with a medical device and a display. Themedical device collects data regarding cardiac events that occurred attwo or more cardiac sites. For example, the medical device collects datafrom two or more electrodes distributed in a single cardiac chamberand/or distributed in separate cardiac chambers. These cardiac events atthese sites are represented in the display. The display provides a graphof the data as two or more statistical distributions for the two or moresites. In one embodiment, the graph is a histogram that generallycomprises a plurality of histogram bins. Each of these histogram binsincludes statistical distributions of cardiac events, and generallyincludes a first cardiac event distribution and a second cardiac eventdistribution. The first cardiac event distribution represents ordisplays cardiac events that occurred at a first cardiac site, and thesecond cardiac event distribution represents or displays cardiac eventsthat occurred at a second cardiac site. According to one embodiment, thehistogram provides both a right ventricular cardiac event distributionand a left ventricular cardiac event distribution in these histogrambins.

In one embodiment, the first cardiac event distribution is adjacent tothe second cardiac event distribution in these histogram bins. In analternative embodiment, the histogram further comprises a histogram axisthat extends through each of the histogram bins. The first and secondcardiac event distributions are on opposing sides of this histogramaxis. In either of these embodiments, the cardiac events that occurredat these two sites are presented in a meaningful manner as statisticalor frequency distributions in a graph that assists a viewer in comparingthese cardiac events to, for example, evaluate a therapy. According toone embodiment, the first and second cardiac event distributions eachprovide distributions for both sensed intrinsic cardiac events and pacedcardiac events. The first and second cardiac event distributions aredistinguished using different colors, and the sensed and paced cardiacevent distributions are distinguished using different fillings.

Another aspect provides a system that generally comprises a medicaldevice and a programmer. The medical device, such as a pacemaker ordefibrillator, collects data regarding cardiac events that occurred attwo or more cardiac sites. The programmer communicates with the medicaldevice, retrieves the data, and displays the data in a graph as two ormore statistical distributions for the two or more sites. According toone embodiment, the graph is a histogram that includes a rightventricular cardiac event distribution and a left ventricular cardiacevent distribution.

Another aspect provides a histogram for representing cardiac events thatoccur at two or more cardiac sites. The histogram generally comprises aplurality of histogram bins for the two or more statisticaldistributions. Each of the histogram bins generally includes at least afirst cardiac event distribution and a second cardiac eventdistribution. The first cardiac event distribution represents ordisplays cardiac events that occurred at a first cardiac site, and thesecond cardiac event distribution represents or displays cardiac eventsthat occurred at a second site. According to one embodiment, the firstcardiac event distribution is a right ventricular cardiac eventdistribution, and the second cardiac event distribution is a leftventricular cardiac event distribution.

Another aspect provides a computer-readable medium encoded with asoftware program. The software program provides statisticaldistributions for two or more cardiac sites. The software programretrieves data regarding cardiac events occurring at these sites.According to one embodiment, the cardiac events are represented in aplurality of histogram bins in which each bin includes a first andsecond cardiac event distribution.

Another aspect provides a method that generally comprises retrievingdata regarding cardiac events that occurred or are occurring at two ormore sites, and displaying the data in a graph as two or morestatistical distributions for the two or more sites. According to oneembodiment, displaying the data comprises providing a histogram having aplurality of histogram bins for the distributions, and providing a firstcardiac event distribution and a second cardiac event distribution. Thefirst cardiac event distribution represents cardiac events that occurredat a first site, and the second cardiac event distribution representscardiac events that occurred at a second site. According to oneembodiment, the histogram includes a left ventricular cardiac eventdistribution and a right ventricular cardiac event distribution. Also,according to one embodiment, the statistical distribution includessensed intrinsic cardiac events and paced cardiac events.

In one embodiment, the two or more sites include: at least one leftventricle site and at least one right ventricle site; at least two leftventricle sites; at least two right ventricle sites; at least one leftatrium site and at least one right atrium site; at least two left atriumsites; at least two right atrium sites; at least two sites in a firstventricle and at least one site in a second ventricle; or at least twosites in a first atrium and at least one site in a second atrium.According to one embodiment, the cardiac event distribution displayed inthe histogram is determined by dividing an event count in bin by adenominator. The denominator is the sum of a total primary site sensecount, a total primary site pace count, and a total secondary pacecount. The secondary pace count includes only secondary pacing events inwhich no primary pace is delivered for a corresponding cardiac cycle.

In the embodiments provided above, the inclusion of first and secondstatistical distributions does not preclude the inclusion of additionaldistributions; i.e. third, fourth, etc. distributions. Additionally, theinclusion of the first and second cardiac sites does not preclude theinclusion of additional cardiac sites in additional locations; i.e.third, fourth, etc. cardiac sites.

These and other aspects, features, embodiments and advantages of theinvention will become apparent from the following description of thepreferred embodiments of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of a system according to one embodiment.

FIG. 2 is a block diagram of one embodiment of the system of FIG. 1.

FIG. 3 is a first example of a cardiac event graph in which a first andsecond cardiac event distributions are adjacent to each other in ahistogram bin.

FIG. 4 is a second example of a cardiac event graph in which a first andsecond cardiac distributions are on opposing sides of a histogram axis.

FIG. 5 is a flow diagram representing method and software programaspects.

FIG. 6 is an example of the cardiac event graph illustrating a desiredtherapy in which atrial tracking results in BV pacing.

FIG. 7 is an example of the cardiac event graph illustrating a desiredtherapy in which atrial tracking results in RV pacing.

FIG. 8 is an example of the cardiac event graph illustrating a desiredtherapy in which atrial tracking results in LV pacing.

FIG. 9 is an example of the cardiac event graph illustrating acompromised therapy in which there is significantly reduced LV pacingdue to LV oversensing.

FIG. 10 is an example of the cardiac event graph illustrating acompromised therapy in which there is reduced BV pacing due to the PRinterval being smaller than the AV delay independent of rate.

FIG. 11 is an example of the cardiac event graph illustrating acompromised therapy in which there is reduced BV pacing due to the PRinterval being smaller than the AV delay at elevated rates.

DETAILED DESCRIPTION

In the following detailed description, references are made to theaccompanying drawings that illustrate specific embodiments in which theinvention may be practiced. Changes in the electrical, mechanical,structural, logical or programming designs may be made to theembodiments without departing from the spirit and scope of the presentinvention. The following detailed description is, therefore, not to betaken in a limiting sense and the scope of the present invention isdefined by the appended claims and their equivalents.

The present subject matter addresses the aforementioned problems, andprovides a graph of cardiac event data as two or more statisticaldistributions for the two or more sites. The graph allows a user to viewand compare cardiac events at two or more cardiac sites in a meaningfulmanner. In one embodiment, the graph is a single histogram thatgenerally comprises a plurality of histogram bins. The histogram binsrepresent cardiac events, and each of the histogram bins generallyincludes a first cardiac event distribution for cardiac events thatoccurred at a first site, and a second cardiac event distribution forcardiac events that occurred at a second site. Aspects of the presentsubject matter are provided herein.

One aspect, as illustrated in FIG. 1, is a cardiac rhythm managementsystem 10. The system 10 generally comprises a medical device 12 and aprogrammer 14. The medical device 12 includes but is not limited tocardiac stimulation devices such as pacemakers and defibrillators. Inaddition to other functions, the medical device 12 collects dataregarding cardiac events that occurred or are occurring at two or morecardiac sites, i.e. two or more locations in or around a heart.

The medical device 12 has an electrode system 16 comprised of at leastone lead and at least one electrode 24 for each lead. FIG. 1 shows anexample in which there are three leads 18. The illustrated leads 18 areinserted into a patient's heart 26. The electrodes 24 transmitelectrical signals or paces to the heart 26 and receive or senseintrinsic electrical signals from the heart 26. The lead(s) 18 andelectrode(s) 24 are arranged, programmed and/or otherwise configured inan attempt to optimize the operation of the medical device 12 for aparticular patient.

The leads 18 and the electrodes 24 are physically arranged with respectto the heart 26 to properly transmit pace pulses and sense intrinsicsignals from the heart 26. The medical device 12 is programmed to pace acardiac event using a particular electrode or electrodes 24 and to sensea cardiac event using a particular electrode or electrodes 24. As such,the cardiac sites at which the cardiac events take place are determinedby the position of the electrodes 24. For example, as generally shown inFIG. 1, a lead 18 may be inserted into the right atrium 42 and ventricle44 so that an electrode 38 is positioned in the right atrium 42 andanother electrode 40 is positioned in the right ventricle 44. A secondlead 18 may be inserted through the coronary sinus and onto the leftventricle 52 (coronary sinus implant) so that electrodes 46 and 48 arepositioned on the left ventricle 52, i.e. in the coronary vein locatedoutside the ventricle, and form a dual electrode configuration for theleft ventricle 52.

The medical device 12, with its electrode system 16, is adapted forcollecting data regarding cardiac events occurring at two or morecardiac sites. In some variations or configurations, electrodes 24 aredistributed among two or more of the chambers 42, 44, 50 and 52 of theheart 26. And in other variations, two or more electrodes 24 may be in asingle chamber of the heart 26, such as in the left ventricle 52 asillustrated in FIG. 1. Therefore, a non-exclusive list of availablevariations of the positions of the electrodes 24, and thus the cardiacsites, include a first site in a first cardiac chamber and a second sitein a second cardiac chamber, a first site and a second site in a firstcardiac chamber, and a first site and a second site in a first cardiacchamber and a third site in a second cardiac chamber. In one embodiment,the two or more sites include: at least one left ventricle site and atleast one right ventricle site; at least two left ventricle sites; atleast two right ventricle sites; at least one left atrium site and atleast one right atrium site; at least two left atrium sites; at leasttwo right atrium sites; at least two sites in a first ventricle and atleast one site in a second ventricle; or at least two sites in a firstatrium and at least one site in a second atrium.

FIGS. 1 and 2 show the programmer 14 coupled or otherwise incommunication with the medical device 12. In one embodiment, theprogrammer 14 is coupled through complementary telemetry circuits 28that provide a radio frequency telemetry channel 30 between theprogrammer 14 and the device 12. The medical device 12 has programmableparameters that are adjusted in an attempt to optimize the medicaldevice 12 for a particular patient, and the programmer 14 is used tochange or program these parameters. Also, as discussed above, themedical device 12 collects cardiac event data, such as paced cardiacevents and sensed intrinsic cardiac events, and stores it in memory 80.This data is transferred from the medical device 12, through thecommunication channel 30, and to the programmer 14, which has means forretrieving and displaying the data regarding these cardiac events. Theprogrammer 14 retrieves the data regarding the cardiac events at thesecardiac sites, and provides a graph 32 of these cardiac events.

In one embodiment, the graph 32 is, or is formed on, an electronicscreen display 34 such as a CRT monitor or a liquid crystal display LCD,for example, that forms an integral part of the programmer 14. In otherembodiments, the display 34 includes other means for displaying thegraph 32 of cardiac events, including but not limited to, printing outthe graph 32 on a printer, and projecting the graph 32 of cardiac eventson a device in communication with the programmer 14 such as, forexample, a local peripheral device, a remote device, or a devicenetworked to the programmer 14. Thus, the graph 32 may be produced asboth a printed and projected image.

As discussed earlier, in addition to its ability to pace and sensecardiac events, the medical device 12 provides means for collecting dataregarding cardiac events that occurred at various cardiac sites where anelectrode 24 is located, and collects or records data regarding thesecardiac events in a memory 80. This data includes sensed intrinsiccardiac events such as sensed P waves and sensed R waves and/or pacedcardiac events that have been induced by the medical device 12. Thesecardiac events are then able to be displayed by the programmer 14, whichhas means for retrieving data and further has means for representing thecardiac events occurring at these sites in a graph 32 on a display 34.In one embodiment, these means for retrieving data and means forrepresenting the cardiac events are provided by hardware andprogramming.

In one embodiment, as generally illustrated in FIGS. 3 and 4, the graph32 is a histogram 100 that generally comprises a plurality of histogrambins 102 that provide a statistical distribution of the cardiac eventsfor these sites. Each histogram bin 102 includes a first cardiac eventdistribution 104 for cardiac events that occurred at a first cardiacsite, and a second cardiac event distribution 106 for cardiac eventsthat occurred at a second cardiac site. The ventricular histogram hasbins 102 that represent cardiac events that occur at a particular rate.For example, the illustrated histogram has bins 102 that representcardiac events within ten beats per minute intervals (i.e. “30-39” beatsper minute, “40-49” beats per minute, and up to “240-249” beats perminute). The increment used to define the histogram bins 102 may vary asdesired for an application.

In the embodiment illustrated in FIG. 3, the first cardiac eventdistribution 104 is adjacent to the second cardiac event distribution106. Referring to the “60-69” bin, the second cardiac event distribution106 is provided adjacent to the first cardiac event distribution 104. Inthis illustrated embodiment, the first cardiac event distribution 104represents right ventricular cardiac events, and the second cardiacevent distribution 106 represents left ventricular cardiac events. Otherembodiments display other cardiac event distributions for other cardiacsites. And as illustrated in the embodiment shown in FIG. 3, theprogrammer 14 further provides a second histogram, i.e. atrial histogram108, to represent atrial events. This second histogram 108 shows thepaced and sensed atrial cardiac events, and further displays aprogrammed atrial trigger rate (ATR) 110. The second histogram 108supplements the first histogram 100 that provides a graph of the cardiacevent data as two or more statistical distributions for the two or morecardiac sites. As will be discussed below with respect to FIGS. 6through 11, the second histogram 108 along with the first histogram 100provides a way in which a clinician can compare ventricular cardiacevents against atrial cardiac events.

Additionally, in one embodiment, a color scheme is used to distinguishthe various distributions in the graph 32. Color schemes include the useof colors that display well on color monitors or printers, or gray tonesfor black and white monitors and printers. In the illustrated example ofFIG. 3, the sensed event in the right ventricle is darker than thesensed event in the left ventricle. Additionally, the distributions arefurther distinguishable using different fillings. In the illustratedexample of FIG. 3, a same color is used to display the paced events 112and sensed events 114 for the right ventricle. Additionally, a samecolor is used to display paced events 112 and sensed events 114 for theleft ventricle. The color used for the left ventricle is different thanthe color used for the right ventricle. The paced events 112 and thesensed events 114 are distinguished by using a hatched filling for thepaced events 112 and a solid filling for the sensed events 114. Althoughthe exact color scheme or fill scheme used may vary, these schemesenhance the ability of the graph 32 to quickly and easily convey orrepresent the cardiac events in a meaningful way for viewing andcomparison.

In another embodiment illustrated in FIG. 4, the histogram 100 furthercomprises a histogram axis 116 extending through each of the histogrambins. In this embodiment, each histogram bin 102 includes a firstcardiac event distribution 104 and a second cardiac event distribution106, with the first cardiac event distribution 104 and the secondcardiac event distribution 106 on opposing sides of the histogram axis116. Both the embodiment illustrated in FIG. 3 and the embodimentillustrated in FIG. 4 provide a histogram 100 that allows a user to viewand compare cardiac events at two or more sites in a meaningful manneras frequency distributions.

FIG. 2 illustrates a block diagram of the system 10 shown in FIG. 1. Inone embodiment, the medical device 12 is a programmablemicroprocessor-based system that generally comprises a processor 78, amemory 80, a telemetry circuit 28, pulse/sense circuitry 82, and a powersupply or battery 84. The processor 78 and memory 80 are used to controlthe process steps conducted by the medical device 12. For example, theprocessor 78 is programmed to detect a sensed condition or response in apatient's heart 26 and to respond appropriately. The memory 80 containsparameters for various pacing and sensing modes, and further stores dataconcerning the condition of the heart 26 as derived from the receivedcardiac signals. In one embodiment, this stored data includes dataregarding paced and sensed cardiac events. The medical device 12 usesthe pulse/sense circuitry 82 to interface with the lead electrodes 24,i.e. to transmit the signal to the heart 26 and to receive the signalfrom the heart 26 through these electrodes 24. The telemetry circuit 28enables the medical device 12 and the programmer 14 to communicate witheach other.

The illustrated programmer device 14 provides another aspect of thepresent subject matter. The programmer 14 generally comprises aprocessor 86, a circuit 28 for communicating with a medical device 12,an input user interface 88, an output user interface 90, memory 92 and apower supply 94. In one embodiment, the circuit for communicating with amedical device comprises telemetry circuitry 28. As discussed earlier,the medical device 12 is capable of collecting or acquiring data forboth sensed and paced cardiac events occurring at two or more cardiacsites. This data is transferred, retrieved or otherwise acquired by theprogrammer 14 through the communication circuitry 28.

In one embodiment, the input user interface 88 includes, but is notlimited to, a keyboard 96, a mouse 98, a light pen and a touch screen.Further, the output user interface 90 includes, but is not limited to,printers and displays. In one embodiment, the graph 32 is, or is formedby, an electronic screen display 34 such as a CRT monitor or LCD, forexample, that forms an integral part of the programmer 14. In otherembodiments, the display 34 includes other means for displaying cardiacevents, including but not limited to, printing or projecting the graph32 of the cardiac events on a device in communication with theprogrammer 14 such as, for example, a local peripheral device, a remotedevice, or a device networked to the programmer 14. Thus, the graph 32may be produces as both a printed and a projected image.

Thus, according to this aspect, the programmer device 14 generallycomprises circuitry 28 for communicating with a medical device 12, and adisplay 34 upon which the graph 32 is produced. The circuitry 28provides means for communicating with a cardiac stimulation device ormedical device 12 that is adapted for collecting data regarding cardiacevents occurring at two or more cardiac sites.

The medical device 12 distributes electrodes 24 to the heart 26 toprovide cardiac sites from which cardiac events are collected. In onevariation, the medical device 12 distributes two or more electrodes 24into one chamber of the heart. In another variation the medical device12 distributes at least one electrode 24 into two or more chambers. Inyet another variation the medical device 12 distributes two or moreelectrodes 24 into one chamber and at least one electrode 24 into two ormore chambers of the heart. As discussed above, these electrodes 24 areconfigured to either pace a cardiac event or to sense an intrinsiccardiac event, and the display 32 represents the cardiac events thatoccurred at the two or more sites where electrodes 24 are positioned. Inone embodiment, the data collected by the medical device 12 anddisplayed include both paced cardiac events 112 and sensed intrinsiccardiac events 114. And since the medical device 12 is able todistribute the electrodes 24 in a number of ways, the two or more sitesfrom which the cardiac event data are collected and displayed include: afirst site in a first cardiac chamber and a second site in a secondcardiac chamber; a first site and a second site in a first cardiacchamber; and a first site and a second site in a first cardiac chamberand a third site in a second cardiac chamber. These illustratedvariations are not exhaustive or exclusive, but rather illustrate thatmultiple cardiac sites from which the cardiac events are collected anddisplayed may be distributed in one and/or among two or more chambers ofa heart. Appropriate hardware and programming provide means forretrieving the data, and means for representing the cardiac eventsoccurring at the cardiac sites in a display 32.

The graph 32 already has been discussed above with respect to the systemaspect 10, and now is generally discussed here with respect to theprogrammer device 14. In one embodiment of the programmer device 14, thegraph 32 is a histogram 100. The histogram 100 comprises a plurality ofhistogram bins 102 that provide frequency distribution(s) forrepresenting cardiac events. Each histogram bin includes a first and asecond cardiac event distribution 104 and 106. The first cardiac eventdistribution 104 represents cardiac events that occurred at a firstcardiac site, and the second cardiac event distribution 106 representscardiac events that occurred at a second cardiac site. In oneembodiment, the first cardiac event distribution 104 is adjacent to thesecond cardiac event distribution 106. In an alternative embodiment, thehistogram 100 further comprises a histogram axis 116 extending througheach of the histogram bins 102. The first cardiac event distribution 104and the second cardiac event distribution 106 are on opposing sides ofthis axis 116.

According to one embodiment, the first cardiac event distribution 104and the second cardiac event distribution 106 each include both pacedcardiac events, i.e. a paced cardiac event distribution 112, and sensedintrinsic cardiac events, i.e. a sensed cardiac event distribution 114.Within this embodiment, the first cardiac event distribution 104 and thesecond cardiac event distribution 106 are formed by a summation of thepaced cardiac event distribution 112 and the sensed cardiac eventdistribution 114. According to one embodiment as illustrated in FIG. 3,the first cardiac event distributions 104 and the second cardiac eventdistributions 106 are distinguished using different colors, and thedistributions associated with the paced cardiac events 112 and thesensed intrinsic cardiac events 114 are distinguished using differentfillings. In the specific embodiment illustrated in FIG. 3, thehistogram 100 represents both a right ventricular cardiac eventdistribution 104 and a left ventricular cardiac event distribution 106,and further includes a second histogram 108 to represent atrial events.

Another aspect provides a histogram 100 for providing a statisticaldistribution of the cardiac event data for the two or more sites. Thegraph 32 has already been discussed above with respect to the systemaspect 10 and programmer device 14 aspect, and now is discussed herewith respect to the histogram display aspect 100. The histogram display100 generally comprises or provides a plurality of histogram bins 102that represent cardiac events. Each of the histogram bins 102 include afirst cardiac event distribution 104 or a portion thereof and a secondcardiac event distribution 106 or a portion thereof. The first cardiacevent distribution 104 represents cardiac events that occurred at afirst cardiac site, and the second cardiac event distribution 106represents cardiac events that occurred at a second cardiac site. Evenif no cardiac events occurred in a bin 102, there still is a cardiacevent distribution, or representation of the cardiac event, for that binbecause it represents that no event occurred with respect to that bin.For example, in the “40-49” rate bin of FIG. 3, the first cardiac eventdistribution 104 and the second cardiac event distribution 106 are zero.

In one embodiment of the histogram, as generally illustrated in FIG. 3,the first cardiac event distribution 104 is adjacent to the secondcardiac event distribution 106 in each of the histogram bins 102, i.e.portions or representations of the distributions are provided adjacentto each other in each bin. For example, the “60-69” bin 102 of FIG. 3contains both the first cardiac event distribution 104 and the secondcardiac event distribution 106 side-by-side. In an alternativeembodiment, as generally illustrated in FIG. 4, a histogram axis 116extends through each of the histogram bins 102, and the first cardiacevent distribution 104 and the second cardiac event distribution 106 areon opposing sides of the histogram axis 116.

Because of the variety of ways in which the electrodes 24 of the medicaldevice 12 can be arranged in a heart 26, there are a variety ofcombinations of cardiac sites from which cardiac event data iscollected. In one variation, the first cardiac site is in a firstcardiac chamber and the second site is in a second cardiac chamber. Oneembodiment of this variation is reflected in the histogram 100 of FIG.3, in which the first cardiac event distribution 104 is a rightventricle 44 distribution and the second cardiac event distribution 106is a left ventricle 52 distribution. In another variation, the firstcardiac site and the second cardiac site are in a first cardiac chamber.In yet another variation, there is a third cardiac event distributionfor cardiac events at a third site. The first site and the second siteare in a first cardiac chamber, and the third site is in a secondcardiac chamber. These variations are provided as examples, and not asan exclusive list.

In one embodiment the first cardiac event distribution 104 and thesecond cardiac event distribution 106 each include both paced cardiacevents 112 and sensed intrinsic cardiac events 114. In one embodiment ofthe histogram 100, the first and second event distributions 104 and 106are distinguished using different colors, and the distributions for thepaced cardiac events 112 and the sensed intrinsic cardiac events 114 aredistinguished using different fillings.

In one embodiment as illustrated in FIG. 3, the graph 32 includes tachyzone rate thresholds 120. The medical device 12 provides a particulartherapy for the ventricular tachycardia, i.e. VT, a condition of thepatient that is represented by these zones. Tachycardia is cardiacarrhythmia characterized by a rapid rate. This rapid rate may be normalas if induced by exercise, or may indicate a pathology. These tachy zonerate thresholds 120 are programmed boundaries that define zones orstages for a particular patient's condition for which a defibrillator,for example, applies either specially timed shocks or pulses or a highvoltage shock to the heart muscle to interrupt or disrupt the fastrhythm. In the illustration of FIG. 3, these zones include a ventricularfibrillation zone (VF) 122, a ventricular tachycardia zone (VT) 124, anda pre ventricular tachycardia zone (VT-1) 126. These zone ratethresholds 120 assist a user with evaluating therapy.

In one embodiment, the histogram 100 may be projected on an electronicdisplay or screen display 34 such as a CRT monitor or LCD. In anotherembodiment, the histogram 100 is printed on a printer. In oneembodiment, the histogram 100 is provided by the programmer device 14 toan integral monitor or printer, a local peripheral, a networkedresource, or a remote resource. In another embodiment, another devicesuch as a stand-alone display device separate from the programmer 14provides the histogram 100. This stand-alone display device has meansfor retrieving the data regarding the cardiac events occurring at thecardiac sites, and further has means for providing a graph 32representing these cardiac events.

Another aspect provides a software program 200 that provides aprogramming interface for an implantable medical device 12. FIG. 5illustrates a flow chart for the software program 200. The softwareprogram 200 is encoded in a computer-readable medium, i.e. the memory 92of the programmer 14 for example. The illustrated software program 200generally executes the following: at 202, retrieving data regardingcardiac events occurring at two or more sites; and at 204, representingthe cardiac events occurring at the two or more sites in a graph 32.Receiving data regarding cardiac events requires a collected data input206 for the sites. As illustrated, this collected data is from the firstand second cardiac sites. The present subject matter is not limited totwo cardiac sites. The illustration shows that data may be taken from athird site or even additional sites, i.e. an Nth site. In oneembodiment, this data is collected by the medical device 12 and isstored in the memory 80 of the medical device 12.

The graph 32 generated by the software program 200 generally comprises aplurality of histogram bins 102 that represent cardiac events. Eachhistogram bin 102 includes a first cardiac event distribution 104 forcardiac events that occurred at a first cardiac site, and a secondcardiac event distribution 106 for cardiac events that occurred at asecond cardiac site. In one embodiment, the first cardiac eventdistribution 104 is adjacent to the second cardiac event distribution106. Therefore, in one embodiment, representing the cardiac events inone display generally comprises: at 208, providing a histogramdistribution 100 having a plurality of histogram bins 102; and at 210,providing a 1st, 2nd and even up to an Nth cardiac event distribution,or a portion or representation thereof, in one histogram bin 102.

Because of the variety of ways in which the electrodes 24 of the medicaldevice 12 can be arranged in or proximate to a heart 26, there are avariety of combinations of cardiac sites from which cardiac event datais collected. In one variation, the first site is in a first cardiacchamber and the second site is in a second cardiac chamber. In oneembodiment that represents this variation, the first cardiac eventdistribution 104 is a right ventricle 44 cardiac event distribution andthe second cardiac event distribution 106 is a left ventricle 52 cardiacevent distribution. In another variation, the graph 32 further comprisesa third cardiac event distribution for cardiac events at a third site.The first site and the second site are in a first cardiac chamber, andthe third site is in a second cardiac chamber. This third cardiac eventdistribution forms a third column adjacent to the first and secondcardiac event distributions 104 and 106, or portions thereof, in thebins.

Additional features of the display 32 have been discussed above withrespect to the system 10, programming device 12 and histogram display100 aspects of the present subject matter.

Another aspect, also as generally illustrated in FIG. 5, provides amethod 300 that generally comprises: at 202, retrieving data regardingcardiac events occurring at two or more sites; and at 204, representingthe cardiac events occurring at the two or more sites in a graph 32.

In one embodiment, representing the cardiac events comprises: at 208,providing a histogram 100 having a plurality of histogram bins 102representing cardiac events; and at 210, providing a first cardiac eventdistribution 104 and a second cardiac event distribution 106 in one ofthe histogram bins 102. The first cardiac event distribution 104represents cardiac events that occurred at a first site and the secondcardiac event distribution 106 represents cardiac events that occurredat a second site.

In one embodiment, providing at 208 a first cardiac event distribution104 and a second cardiac event distribution 106 in one of the histogrambins 102 comprises providing the first cardiac event distribution 104adjacent to the second cardiac event distribution 106. In an alternativeembodiment, providing at 208 a first cardiac event distribution 104 anda second cardiac event distribution 106 in one of the histogram bins 102comprises providing a histogram axis 116, and providing the firstcardiac event distribution 104 and the second cardiac event distribution106 on opposing sides of the histogram axis 116.

Because of the variety of ways in which the electrodes of the medicaldevice 12 can be arranged in or proximate to a heart 26, there are anumber of variations with respect to the cardiac sites. In onevariation, the first cardiac site is in a first cardiac chamber and thesecond cardiac site is in a second cardiac chamber. In one embodimentthat represents this variation, the first cardiac event distribution 104is a right ventricle 44 distribution and the second cardiac eventdistribution 106 is a left ventricle 52 distribution.

In one embodiment, providing a first cardiac event distribution 104 anda second cardiac event distribution 106 in one of the histogram bins 102comprises providing a first cardiac event distribution 104, a secondcardiac event distribution 106 and a third cardiac event distribution inone of the histogram bins. The third cardiac event distribution isrepresented as a third column in the histogram bin 102, and representscardiac events that occurred at a third cardiac site. In thisembodiment, the first cardiac site and the second cardiac site are in afirst cardiac chamber, and the third cardiac site is in a second cardiacchamber.

Additional features of the graph 32 have been discussed above withrespect to the system aspect of the present invention.

FIGS. 6 through 11 provide examples of how the cardiac event display isused to provide the clinician with diagnostics that reveal loss oftherapy. The examples provided herein are nonexclusive. FIGS. 6, 7 and 8provide examples of the cardiac event display illustrating a desiredtherapy, and FIGS. 9, 10 and 11 provide examples of the cardiac eventdisplay illustrating a compromised therapy.

FIG. 6 provides an example of the cardiac event graph 32 illustrating adesired therapy in which atrial tracking results in BV pacing. Thehistogram 100 illustrates BV therapy, i.e. pacing in both the right andleft ventricles as illustrated by the first and second cardiac eventdistributions 104 and 106, being delivered across all occurring atrialrates as illustrated by the atrial histogram 108. The illustrated pacedRV and LV events are the desired therapy when the device is programmedto deliver BV therapy.

FIG. 7 provides an example of the cardiac event graph 32 illustrating adesired therapy in which atrial tracking results in RV pacing. Thehistogram 100 illustrates RV therapy, i.e. pacing in the right ventricleas illustrated by the first cardiac event distribution 104, beingdelivered across all occurring atrial rates as illustrated by the atrialhistogram display 108. The illustrated paced RV events are the desiredtherapy when the device is programmed to deliver RV therapy.

FIG. 8 provides an example of the cardiac event graph 32 illustrating adesired therapy in which atrial tracking results in LV pacing. Thehistogram 100 illustrates LV therapy, i.e. pacing in the left ventricleas illustrated by the second cardiac event distribution 106, beingdelivered across all occurring atrial rates as illustrated by the atrialhistogram 108. The illustrated paced LV events are the desired therapywhen the device is programmed to deliver LV therapy.

FIG. 9 provides an example of the cardiac event graph 32 illustrating acompromised therapy in which there is significantly reduced LV pacingdue to LV oversensing. The histogram 100 illustrates the compromise intherapy due to LV (left ventricle) sensing occurring before theventricular escape interval. The ventricular escape interval is theperiod between a ventricular sensed event and the next ventricularoutput pace. In medical devices that use only RV (right ventricle)sensing to reset the ventricular escape time, these LV senses willinhibit LV pacing but not RV pacing. Therefore, the loss of LV pacing,but not RV pacing, as illustrated by the sensed event 114 in the leftventricle cardiac event distribution 106 in this histogram 100represents LV oversensing and has significant diagnostic value to theclinician. The clinician may be able to mitigate this loss of therapy byreprogramming the sensing characteristics of the LV channel, such assensing level, refractory time, and blanking time.

FIG. 10 provides an example of the cardiac event graph 32 illustrating acompromised therapy in which there is reduced BV pacing due to the PRinterval being smaller than the AV delay independent of rate. Thehistogram 100 illustrates the compromise in therapy due to sensing theRV, i.e. the sensed event 114 in the right ventricle cardiac eventdistribution 104, some of the time across all atrial rates asillustrated by the atrial histogram 108. This illustrates what wouldoccur in a patient when the PR interval is shorter than the programmedAV delay much of the time and is not dependent on rate. The PR intervalis the period between an atrial sensed event (P) and a ventricularsensed event (R), and the AV delay is the period between an atrialsensed or paced event and the delivery of a ventricular pace pulse. Theclinician may be able to mitigate this loss of therapy by reprogrammingthe fixed AV delay to a shorter period.

FIG. 11 provides an example of the cardiac event graph 32 illustrating acompromised therapy in which there is reduced BV pacing due to the PRinterval being smaller than the AV delay at elevated rates. Thehistogram 100 illustrates the compromise in therapy due to sensing theRV at elevated atrial rates. This illustrates what would occur in apatient when the PR interval decreases with increasing rate andeventually gets shorter than the programmed AV delay. The clinician mayable to mitigate this loss of therapy by reprogramming the AV delay fromfixed to dynamic or more aggressively reprogramming the AV delay if itis already enabled.

Pacemakers can enforce a minimum heart rate either asynchronously orsynchronously. In asynchronous pacing, the heart is paced at a fixedrate irrespective of intrinsic cardiac activity. There is thus a riskwith asynchronous pacing that a pacing pulse will be deliveredcoincident with an intrinsic beat. Most pacemakers for treatingbradycardia today are therefore programmed to operate synchronously in aso-called demand mode where sensed cardiac events occurring within adefined interval either trigger or inhibit a pacing pulse Inhibiteddemand pacing modes utilize escape intervals to control pacing inaccordance with sensed intrinsic activity. In an inhibited demand mode,a pacing pulse is delivered to a heart chamber during a cardiac cycleonly after expiration of a defined escape interval during which nointrinsic beat by the chamber is detected. If an intrinsic beat occursduring this interval, the heart is thus allowed to “escape” from pacingby the pacemaker. Such an escape interval can be defined for each pacedchamber. For example, a ventricular escape interval can be definedbetween ventricular events so as to be restarted with each ventricularsense or pace. The inverse of this escape interval is the minimum rateat which the pacemaker will allow the ventricles to beat, sometimesreferred to as the lower rate limit (LRL). A ventricular escape intervalcan also be triggered by an atrial sense in an atrial tracking mode.

In ventricular resynchronization therapy, one or both ventricles arepaced in an attempt to improve the coordination of ventricularcontractions. In a ventricular resynchronization pacing mode, pacingstimulation is applied to one or both ventricles in a manner thatimproves the coordination of ventricular contractions and therebyimprove ventricular pumping efficiency.

In delivering such therapy, for example, it may be useful to pace onlyone ventricle on an inhibited demand basis in accordance with sensesignals received from the opposite ventricle, pace one ventricle in atriggered mode in which an intrinsic beat in one ventricle triggers apace in the opposite ventricle, pace both ventricles on an inhibiteddemand basis in accordance with sense signals received from only oneventricle, or pace both ventricles in a combination of triggered andinhibited demand modes. In the examples of resynchronization therapythat follow, the ventricular pacing modes are based upon intrinsicactivity in the right ventricle. It should be appreciated, however, thatequivalent embodiments could be applied to pacing modes based upon leftventricular intrinsic activity.

One implementation of resynchronization therapy is biventricular (BV)pacing. In BV pacing, a left ventricular pace is delivered eithersimultaneously or in a timed relation with a right ventricle pace asspecified by a biventricular offset interval. The offset interval may bezero in order to pace both ventricles simultaneously, positive in orderto pace the left ventricle after the right, or negative if the leftventricle is paced before the right. In many cases, pumping efficiencyof the heart will be increased by simultaneous pacing of the ventricleswith an offset of zero. However, it may be desirable in certain patientsto pace one ventricle before the other in order to compensate fordifferent conduction velocities in the two ventricles, and this may beaccomplished by specifying a particular biventricular offset interval.The ventricles may be paced on an inhibited demand basis where theventricular escape interval is restarted with either a ventricular paceor a right ventricular sense. The pacing mode may also include atrialtracking. In that case, a pair of ventricular paces are delivered afterexpiration of the AVI escape interval or expiration of the LRL escapeinterval, with ventricular pacing inhibited by a right ventricular sensethat restarts the LRL escape interval or stops the AVI escape interval.Since the ventricular escape interval in this mode is reset or stoppedby senses only from the right ventricle, a left ventricular protectiveperiod may be provided that starts with the occurrence of a leftventricular sense and lasts for a specified time. A left ventricularpace is then not permitted upon expiration of the escape interval if itwould occur with the protective period.

A variation of biventricular pacing is to pace only the left ventricle(LV-only pacing). LV-only pacing may be advantageous where theconduction velocities within the ventricles are such that pacing onlythe left ventricle results in a more coordinated contraction by theventricles than with conventional right ventricular pacing orbiventricular pacing. LV-only pacing may be implemented in inhibiteddemand modes with or without atrial tracking, similar to biventricularpacing. A left ventricular pace is then delivered upon expiration of theAVI escape interval or expiration of the LRL escape interval, with leftventricular pacing inhibited by a right ventricular sense that restartsthe LRL escape interval or stops the AVI escape interval. As with BVpacing, a left ventricular pace may be inhibited if a left ventricularsense occurs within a protective period prior to expiration of theventricular escape interval. Since an inhibited left ventricular pace inthis mode could result in a cardiac cycle with no pacing, the mode maybe further modified such that a right ventricular safety pace isdelivered if the left ventricular pace is inhibited and no rightventricular sense has occurred.

The histogram represents event frequencies that may be produced by apacemaker. In one embodiment, these pacing and sensing frequencies arecalculated. For example, where paces are delivered only to the rightventricle in accordance with a pacing mode based upon right ventricularsenses, the number of senses and paces occurring through the rightventricular channel are counted during each cardiac cycle for aspecified period of time, and each counted sense or pace is assigned toan interval bin representing the R-R interval for that cardiac cycle.The event frequencies, which are expressed as a percentage of totalcardiac cycles during the specified period of time, are calculated asfollows:% RVS in bin=RVS count in bin/total RVS count+total RVP countand% RVP in bin=RVP count in bin/total RVS count+total RVP countwhere RVS is a right ventricular sense and RVP is a right ventricularpace. The denominator in each case is the total count of rightventricular senses and paces during the specified period of time. Sincein an inhibited demand pacing mode based upon right ventricular senses,right ventricular senses and right ventricular paces are mutuallyexclusive for a given cardiac cycle, the denominator represents thetotal number of cardiac cycles. The formula thus correctly computes thefrequency of occurrence for each sense and pace in a particular intervalbin.

In a pacemaker operating in a resynchronization pacing mode that pacesthe left ventricle, using the formula with a denominator as set forthabove will not result in the correct event frequencies. In that case,using the above formula, the frequency of left ventricular senses wouldbe:LVS in bin=LVS count in bin/total LVS count+total LVP countwhich gives an incorrect frequency if right ventricular pacing only isprogrammed since the denominator degenerates to just the total LVScount. Or, if biventricular pacing is programmed with a rightventricular sense frequency of 100% and loss of the left ventricularsensing, the denominator becomes zero.

A pacemaker configured for biventricular pacing and sensing is operatedin a mode where at least one ventricle is paced after expiration of aventricular escape interval without receipt of a ventricular sensesignal from one ventricle designated the primary ventricle, wherein theventricular escape interval is restarted with either a ventricularpacing event or receipt of a sense signal from the primary ventricle.The ventricle other than the primary ventricle is designated thesecondary ventricle. The number of senses and paces occurring througheach ventricular channel during each cardiac cycle are counted for aspecified period of time and with each counted sense or pace assigned toan interval bin representing the R-R interval for that cardiac cycle.The frequency of occurrence for the senses and paces in each intervalbin over the specified period of time is then calculated by dividing thesense and pace count in each bin by a denominator equal to the sum ofthe total sense counts for the primary ventricle, the total pace countsfor the primary ventricle, and the total pace counts for the secondaryventricle only for those cardiac cycles in which no pace was deliveredto the primary ventricle.

In one embodiment, the pacing mode is such that the right ventricle isthe primary ventricle and the left ventricle is the secondary ventricle.For example, only the left ventricle or both ventricles may be paced inan inhibited demand mode based only upon right ventricular senses withleft ventricular senses used only to inhibit left ventricular paces. Theformula for computing event frequencies then becomes:% event in bin=event count in bin/total RVS count+total RVP count+totalLVP countwhere the LVP count includes only those left ventricular pacing eventsin which no right ventricular pace is delivered for that cardiac cycle.Incorporating both the RVP count and the LVP count into the denominatoris beneficial for medical devices that switch autonomously betweenpacing modes (BV, RV and LV) to appropriately pace a patient under avariety of conditions. One condition under which the device may switchincludes the detection of noise on one of the leads, in which case thedevice will pace from a lead without the noise. Another condition underwhich the device may switch includes a reversion to an ATR (Atrial TachyArrhythmia) mode, which occurs if or when the atrial rate is too high.

The reference made above with respect to a primary ventricle and asecondary ventricle also applies in a broader sense to a primary cardiacsite and a secondary cardiac site. These sites include the followingsets of sites: at least one left ventricle site and at least one rightventricle site; at least two left ventricle sites; at least two rightventricle sites; at least one left atrium site and at least one rightatrium site; at least two left atrium sites; at least two right atriumsites; at least two sites in a first ventricle and at least one site ina second ventricle; and at least two sites in a first atrium and atleast one site in a second atrium. One site within each set is a primarycardiac site, and another site within each set is a secondary cardiacsite. A cardiac event distribution is determined by dividing an eventcount in bin by a denominator. The denominator is the sum of a totalprimary site sense count, a total primary site pace count, and a totalsecondary pace count. The secondary pace count includes only secondarypacing events in which no primary pace is delivered for a correspondingcardiac cycle.

The present subject matter, as described above, is not limited to anyparticular chamber of the heart, or combination of chambers, or to anyparticular paced cardiac event or sensed cardiac event. Rather, thepresent subject matter covers any electrode placement inside or outsideof the right and left atriums and ventricles and to various combinationsof cardiac events.

This application is intended to cover any adaptations or variations ofthe present invention. It is manifestly intended that this invention belimited only by the claims and equivalents thereof.

What is claimed is:
 1. A method implemented using processing circuitryexecuting stored executable instructions, the method comprising:acquiring cardiac event data occurring at two or more cardiac sites; anddisplaying the cardiac event data in a histogram as two or morestatistical distributions for the two or more cardiac sites, wherein thehistogram includes a right ventricular cardiac event distribution and aleft ventricular cardiac event distribution.
 2. The method of claim 1,wherein displaying the cardiac event data in the histogram comprisesproviding the right ventricular cardiac event distribution adjacent tothe left ventricular cardiac event distribution in each of the histogrambins.
 3. The method of claim 1, further comprising: determining theright ventricular cardiac event distribution and the left ventricularcardiac event distribution, wherein determining the right ventricularcardiac event distribution and the left ventricular cardiac eventdistribution includes dividing an event count in bin by a denominator,wherein the denominator is the sum of a total right ventricular sense(RVS) count, a total right ventricular pace (RVP) count, and a totalleft ventricular pace (LVP) count, and the LVP count includes only leftventricular pacing events in which no right ventricular pace isdelivered for a corresponding cardiac cycle.
 4. A method implementedusing processing circuitry executing stored executable instructions, themethod comprising: acquiring cardiac event data for both paced andsensed cardiac events, wherein acquiring cardiac event data includesacquiring left ventricle cardiac event data and acquiring rightventricle cardiac event data and displaying the cardiac event data,including displaying a left ventricular cardiac event distributionadjacent to a right ventricular cardiac event distribution in thehistogram, wherein the histogram has a plurality of histogram bins, andthe left ventricular cardiac event distribution includes both paced andsensed cardiac event distributions, and the right ventricular cardiacevent distribution includes both paced and sensed cardiac eventdistributions.
 5. The method of claim 4, further comprising providing anatrial event distribution in a second histogram.
 6. A method implementedusing processing circuitry executing stored executable instructions, themethod comprising: acquiring cardiac event data for two or more cardiacsites; and displaying the cardiac event data in a histogram as two ormore statistical distributions for the two or more sites, the histogramincluding a number of histogram bins, and for each of at least one ofthe histogram bins, the histogram bin including a representation of adistribution for a first cardiac site and a representation of adistribution for a second cardiac site.
 7. The method of claim 6,wherein the first and second cardiac sites include contralateral chambersites.
 8. The method of claim 6, wherein the first and second cardiacsites include sites for a single cardiac chamber.
 9. The method of claim6, wherein acquiring cardiac event data for at two or more sitesincludes acquiring cardiac event data for a left ventricular site and aright ventricular site.
 10. The method of claim 6, wherein acquiringcardiac event data for two or more sites includes acquiring cardiacevent data for a first left ventricular site and a second leftventricular site.
 11. The method of claim 6, wherein acquiring cardiacevent data for two or more sites includes acquiring cardiac event datafor a first right ventricular site and a second right ventricular site.12. The method of claim 6, wherein acquiring cardiac event data for twoor more sites includes acquiring cardiac event data for a left atrialsite and a right atrial site.
 13. The method of claim 6, whereinacquiring cardiac event data for two or more sites includes acquiringcardiac event data for a first left atrial site and a second left atrialsite.
 14. The method of claim 6, wherein acquiring cardiac event datafor two or more sites includes acquiring cardiac event data for a firstright atrial site and a second right atrial site.
 15. The method ofclaim 6, further comprising storing cardiac event data for the two ormore cardiac sites that occur during at least one specified time period,wherein storing the cardiac event data includes storing the cardiacevent data in a memory, and acquiring the cardiac event data includesaccessing the memory to acquire the stored data and displaying the dataincludes displaying at least one histogram using the stored data toprovide a representation of two or more statistical distributions forthe cardiac events at the two or more cardiac sites for each specifiedtime period.
 16. A method implemented using processing circuitryexecuting stored executable instructions, the method comprising:acquiring cardiac event data for two or more cardiac sites in a singlecardiac chamber; and displaying the cardiac event data in a histogram astwo or more statistical distributions for the two or more sites, thehistogram including a number of histogram bins, and for each of at leastone of the histogram bins, the histogram bin including a representationof a distribution for a first cardiac site in the cardiac chamber and arepresentation of a distribution for a second cardiac site in thecardiac chamber.
 17. The method of claim 16, wherein the single cardiacchamber includes a left ventricle.
 18. The method of claim 16, whereinthe two or more cardiac sites include four cardiac sites in the leftventricle.
 19. The method of claim 16, wherein the two or morestatistical distributions include paced and sensed cardiac eventdistributions.
 20. A method implemented using processing circuitryexecuting stored executable instructions, the method comprising:acquiring cardiac event data for a left ventricle from four cardiacsites in the left ventricle; and displaying the cardiac event data in ahistogram as statistical distributions for the four sites in the leftventricle, the histogram including a number of histogram bins, and foreach of at least one of the histogram bins, the histogram bin includinga representation of a distribution for a first of the four cardiac sitesin the left ventricle, a representation of a distribution for a secondof the four cardiac sites in the left ventricle, a representation for athird of the four cardiac sites in the left ventricle, and arepresentation for a fourth of the four cardiac sites in the leftventricle.
 21. The method of claim 20, wherein the statisticaldistributions include paced and sensed cardiac event distributions, anddisplaying the cardiac event data in the histogram as statisticaldistributions for the four sites in the left ventricle includesdisplaying paced and sensed cardiac event distributions.
 22. The methodof claim 20, wherein the representation for at least a portion of thestatistical distribution of the cardiac event for a first of the fourcardiac sites is generally horizontally adjacent to the representationfor at least a portion of a statistical distribution of a cardiac eventfor a second of the four cardiac sites within the at least one of thehistogram bins.
 23. The method of claim 20, wherein the representationfor at least a portion of the statistical distribution of the cardiacevent for a first of the four cardiac sites is generally verticallyadjacent to the representation for at least a portion of a statisticaldistribution of a cardiac event for a second of the four cardiac siteswithin the at least one of the histogram bins.